Costly Cuts

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Why Cutting the Better Access Program will cost us more in the long run

All of us know someone who struggles with mental health issues. We don’t talk about it much, but the impact of mental health is all around us in society. If we leave people to struggle on their own, we can’t expect to prosper as a society. The opposite is also true, that if we lend a helping hand when times are tough, most people end up getting back on their feet sooner rather than later, to the benefit of everyone in society.

The Australian Government recently made the decision to cut federal funding for mental health services in the ‘Better Access to Mental Health Care’ program, abandoning thousands of people with a diagnosed mental health disorder mid-treatment. Here are just a few of the ways that cutting psychological services in Australia will cost us more:

Psychological Treatment Is Inexpensive

If we are serious about tackling mental health in Australia, then people reaching out for help need to be able to access evidence-based psychological support. Over a decade ago, the economic value of psychological services to GDP in Australia was calculated as providing an approximate five-fold return on investment. Mental health issues are one of the leading causes of disability in Australia, preventing people from contributing to the economy and forcing people to depend on support services. People who need therapy must be able to access adequate treatment to prevent unnecessary stays in hospital, tackle welfare dependence, increase productivity and optimise the income of Australians.

Medicare support for people to receive 18 sessions of therapy, ranges between $1468.80 (generalists) to $2156.40 (clinical psychologists). Setting aside problems with the two tiered system of practitioners, these costs are exceptionally low when they are weighed against the direct benefits of this investment. Staying just one night in a hospital for mental health care has been estimated by the Government to cost over $1000 alone. Conversely, the Better Access program supports people in a familiar setting and minimises disruption to a person’s life. For many, these services prevent a stay in hospital, which is essential to consider in the context of the well established links between depression and suicide.

Psychological Treatments Help People Contribute To Society

The Disability Service Pension for a single adult is $670.90 per fortnight, whereas Newstart provides $474.90 per fortnight. People battling common mental health disorders, often require time off work or struggle to maintain stable employment. Balancing the maximum cost of the Better Access program against these figures, the return of investment is paid for in its entirety when people maintain employment even for just 2 to 3 months in any given year. In addition, those who earn $30,000 PA already pay $1740 per year in taxes. Therefore, simply making the transition from welfare to work balances the cost of the psychological intervention. Further to this point, when an individual transitions from 30K to 50K, taxes increase to around $4,500; and likewise, when someone moves from 50K to 70K their taxes increase to around $11,000. Put simply, in many cases, funding psychological services maintains stability in employment for those with a mental health disorder and more than adequately returns the initial investment spent towards their mental health care. Providing people with psychological services when needed helps them become active, maintain productivity, and optimises their contribution to the Australian economy.

Untreated Psychological Problems Cost Society More In Other Areas

There are a wide array of serious secondary effects for many people in Australia when substandard care is offered. Deterioration often happens when people open up sensitive issues and get cut short in treatment. This directly affects many areas of a person’s life, including family life, relationships, alcohol/drug use, and physical health. Some attempt to self-medicate with alcohol or other substances and people with complex dual diagnosis difficulties are at risk of relapse. When substandard care is the only option it can even lead to emotional and physical abuse, or family court appearances. When mental health issues are inadequately treated it draw on the resources of police and in crisis presentations at hospitals. When psychologically distressed people are crying out for help and they are cut off from services, it can lead to self harm and suicide. These negative outcomes represent an enormous cost in human suffering right across society which directly hits our economy.

Psychiatric Care Is More Expensive

The federal Labor Government has repeatedly claimed that people who need more than 10 sessions of therapy can still access up to 50 sessions with a psychiatrist every year. Those who are open to medication may find this useful (if they can get an appointment), but the cost far outweighs any savings from cutting funding to the Better Access program, with psychiatrist consultations ranging from $250 to $400 per consultation. When the difference in cost is calculated, seeing a psychiatrist instead of a psychologist for 18 sessions of therapy will cost the taxpayer over $3000 more and up to $5732 for every client each year. This figure rises sharply with further appointments with a psychiatrist, up to $10,000 per person each year depending on the amount of sessions that are utilised. Given the shortage of psychiatrists and long waiting lists, we have strong doubts that mental health consumers will be able to access appropriate care. In many regions of Australia there no available psychiatrists in the area anyway. The plan to direct people to see a psychiatrist will force many desperate people to spend large amounts of time and money travelling in a state of crisis when they need help, rather than accessing therapists in their local community. Federal politicians seem to have a misconception that psychology and psychiatry are functionally equivalent, despite worldwide acknowledgement of the discrete differences between each.

The ATAPS Scheme Is Less Cost-Effective

So what will people do when they use up 10 appointments? The Federal Government initially said they could still use the ATAPS program, but in October 2011 it was revealed that this is not an option. Those who have a trusted therapist (psychologists, social workers, OTs) are simply being cut off if they are referred via the Better Access program. The implication is that mental health consumers are being herded into treatment with a psychiatrist, or to choose the ATAPS program to begin with, which means they have to start again with a completely different therapist. We know from decades of research that building a relationship of trust with a therapist often requires at least 5 sessions. It is a wasteful use of public money to require people to tell their story over from the beginning again and reestablish trust with a new practitioner. Many distressed people will simple disengage from the system and no longer access appropriate treatment if they are forced to start again with someone else.
The fee-for-service arrangements that are in place for the Better Access to Mental Health Care initiative currently allows for Medicare funds to be focused on genuine psychological services for mental health consumers. The suggestion that funding will be diverted through the ATAPS scheme and other programs, could potentially result in NGOs being able to expend public funding on administration, committee meetings and other functions that do not result in therapy services. With a smaller proportion of funding being directed to psychological services, the cuts to the Better Access program create a situation where public money is being siphoned out of psychological services and into administrative functions. Indeed, the conclusions of an Australian National Audit Office review indicate that up to 25% of the budget spent on ATAPS is consumed by such expenditures, rather than on legitimate mental health services.

Summing It All Up

Mental health disorders are ranked amongst the highest contributing factors to the burden of disease in Australia, with anxiety and depression being the leading cause of years lost due to disability amongst the various disorders. The Better Access to Mental Health Care initiative directly targets people with depression and anxiety and all of the available evidence shows that in approximately 80% of cases the program reaches people with moderate to severe levels of distress. Evaluations show that the Better Access program provides cost-effective treatment for those who in the majority of cases have never accessed mental health care in the past. Other treatment alternatives for these mental health disorders have been shown to be far more expensive to deliver equivalent psychological services. The proposed changes will result in less public money being directed towards actual psychological services for those who need them, and more funds being redirected towards administrative functions. In short, the Government cannot have it both ways on this issue. If on the one hand there are so few people with mental health disorders who access more than 10 sessions of psychological services, then the proposed cutbacks will not produce significant savings. If on the other hand there are significant cost savings to be had by these cutbacks, then it stands to reason that there are a significant proportion of people who are presently utilising these valuable mental health services. When it comes to the mental health of our population, the return on these investments is unquestionable. The only real question is whether the Government considers mental health care a worthwhile investment for our population.

Please sign our online petition and write to our politicians – tell them to reverse the cuts to psychological services. Your comments are welcome below.